An assisted suspension fixation technique in transperitoneal laparoscopic pyeloplasty for infants and young children with ureteropelvic junction obstruction: a retrospective cohort study.

Abstract

Background: Anderson-Hynes pyeloplasty is a classic and highly effective technique for treating congenital ureteropelvic junction obstruction (UPJO). Laparoscopic minimally invasive surgery (MIS) has become the preferred approach for infants and young children. However, a small working area and the complexity of reconstruction procedure pose significant challenges. This study aims to evaluate the efficacy and safety of four-point suspension fixation technique in laparoscopic dismembered pyeloplasty (LDP) for infants and young children with UPJO.

Methods: This retrospective cohort enrolled 37 infants and young children diagnosed with UPJO and underwent transperitoneal LDP between 2014 and 2020. The 37 cases were divided into two Groups based on whether suspension fixation was applied during the transperitoneal LDP. Clinical characteristics and follow-up data of these cohorts were retrospectively collected and analyzed. Continuous variables with a normal distribution were expressed as mean ± standard deviation (SD) and analyzed using independent sample t-tests. Non-normally distributed continuous variables were reported as interquartile range (IQR) and analyzed with the Mann-Whitney U-test.

Results: In Group A, 21 cases underwent conventional LDP without suspension fixation, while in Group B, 16 cases underwent "suspension fixation" LDP. The operative time (237.9±63.0 vs. 186.4±52.3 min, P=0.01), anastomotic suturing completion time (125.2±21.6 vs. 75.9±12.1 min, P<0.001), and postoperative hospital stay duration [6.0 (4.0, 7.5) vs. 4.5 (3.0, 6.5) days, P=0.04] were significantly shorter in Group B than in Group A, and the intraoperative blood loss [15.0 (5.0, 21.0) vs. 7.5 (5.0, 10.8) mL, P=0.04] in Group B was significantly lower than that in Group A. There were no significant differences between the two Groups in preoperative and anteroposterior renal pelvic diameter (APD), postoperative days to drainage tube removal, and postoperative days to removal of double J (D-J) sent. In Group A, one case developed anastomotic stenosis during follow-up, which improved after ureteral balloon dilation. In Group B, one case developed recurrent febrile urinary tract infection (UTI) within two months of D-J stent removal and was ultimately cured with antibiotic treatment during follow-up. The success rates were 95.2% (20/21) in Group A and 93.8% (15/16) in Group B. Other cases who were followed up showed no recurrence of stenosis, urine leakage, or recurrent UTI.

Conclusions: The use of assisted suspension fixation in transperitoneal LDP is safe and efficient for infants and young children, helping to reduce operative time, overcome the small laparoscopic operating area, and address the steep learning curve, making it a valuable approach.